Royal Shrewsbury Hospital

12.30 pm

Mr. Paul Marsden (Shrewsbury and Atcham):
This is a welcome opportunity to place on the record some pertinent questions about the condition of certain hospital buildings known as Copthorne south at the Royal Shrewsbury hospital. There are two acute hospitals in Shropshire--the Princess Royal hospital in the east, in Telford, and the Royal Shrewsbury hospital on the outskirts of Shrewsbury, in the centre and towards the west of the county. The latter services not just the whole county but mid-Wales, which makes it an extremely important hospital.

The Royal Shrewsbury hospital is on a split site. A main road--Mytton Oak road--runs straight through it, from east to west. On the north side is a modern hospital with modern facilities that are brand new or built within the last 20 years or so. On the south side is a ramshackle collection of buildings, some dating back to 1930. Rough macadam roads run around wooden huts, and it is pretty much a disgrace.

In 1997, I had an opportunity to put forward a private finance initiative case to my right hon. Friend the Secretary of State for Health, who was then the Minister of State. I showed him a set of photographs of the Copthorne south buildings. He said that they were some of the "worst hospital buildings" that he had ever seen. Some three and a half years later, we are still using those buildings.

Before I go into detail on those buildings, I want to make it clear that the Royal Shrewsbury hospital has an excellent reputation for care. Under the Government, it has developed and improved a new accident and emergency unit with some £600,000 of investment. It has been given the green light for £1 million of cancer care equipment and a new linear accelerator. Since 1997, it has had more doctors, more nurses and more acute beds. Waiting lists are down for both in-patient and out-patient treatment, and Shropshire health authority has had a massive increase this year and for the next few years of around 6 per cent., which is starting to make a real difference in terms of investment.

Hand in hand with investment goes modernisation. When we put money in, we must get the best possible value out for the national health service. The blame for failing to do so lies fairly and squarely with the Tories, for two reasons. First, they were in power for 18 years, so could have done something about those buildings. Secondly, I was told that a child development centre on the south side was supposed to run for only 15 years until about 1990. However, nothing was ever done about it, and children still have to go there 10 or 11 years after it should have been closed down.

We also inherited in 1997 an incredible amount of red tape and argument between the east and the west of the county. Week after week, there were arguments between the executives of the two hospitals--the Princess Royal and the Royal Shrewsbury--which became very familiar to readers of The Shropshire Star, The Shrewsbury Chronicle and The Telford Journal. Those arguments came about because the Tories had set up competition so that the executives had to fight to the very last bone over investment, planning, resources, staff and so on. The ethos of the Tories was to make sure

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that those hospitals were at each other's throats. Since 1997, that has changed. We are now working towards one hospital on two sites. We already have a joint chief executive and other joint working relationships. Clinicians have also come together. We also have a much better understanding between the public on both sides of the county and within mid-Wales. So it is within that context that I plead the case for the new investment on the understanding that it has to be on the modernisation agenda of the national health service.

Some buildings on the south side date from 1930, but most date from 1945, when, I understand, Canadian solders were enlisted to build a hospital on the Copthorne south site to provide medical facilities for Canadian wounded at the end of the second world war. Those buildings are still being used 56 years later. Forty-four in-patient beds at the Copthorne site are in flat-roofed wooden huts in some of the most appalling conditions that I have ever seen. I have been around the site many times and can provide examples. I record my thanks to Neil Taylor, the joint chief executive at the Princess Royal and the Royal Shrewsbury hospitals for his support. I would also like to thank Tom Caulcott, the chairman, and Graham Seager, the estates manager who is asked to cope with this mess of a building.

For instance, I noticed on one of my tours round that a main electricity switch has to be held up with string, so that it does not turn off all the electricity to a set of administration offices. Most wards containing patients have draughty single-pane windows. There is little ability to control the temperature, so in winter the hospital is extremely cold and in summer it can be very hot. There is no in-between temperature because the heating has to stay on all the time. Water and electricity cables run across the buildings and some of their protective coating is starting to come off. The wood on the outside of the buildings is rotten and paint is peeling off.

There is the phenomenon of rutted floors. In certain wards, ruts run up and down the middle of the ward with beds on either side of them. Those ruts are the width of a trolley, because over the decades the trolleys have been wheeled in and out of the wards and the linoleum, which has been replaced many times, keeps warping. People risk tripping over the flooring, and the lighting is poor. It is obviously a danger in every sense. There are real health and safety problems as well as fire hazards. On one of my tours I asked Mr. Graham Seager, the estates manager, what he would do in the event of a fire alarm, as there is no fire protection for the patients or staff. He told me that there was nothing that anyone could do except evacuate people as quickly as possible and see what happened.

All that is, of course, very inefficient. The heating bills are high, there are problems with mechanical equipment because of the damp, and so on. At the Copthorne south site, some of the facilities are in modern buildings and some in buildings that are 20 or 30 years old. There are 68 medical and rehabilitation in-patient beds, of which, as I mentioned before, 44 are in buildings of the poorest state. There is a day surgery with two theatres, and endoscopy in two rooms. I was shown round a child development centre--I am grateful that I am not a parent who has to take a child with learning difficulties

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around such a single-storey building and out to a back yard that has paving stones lying at all sorts of angles for children to trip over.

A canopy comes from the side of the building, and there is a wooden column, which so rotted that only a metal bracket holds it up, in an area where children have to play. There is a day hospital, a physiotherapy department-- which I must thank for getting me back up and running when my knees gave way--a locomotor assessment unit, a dietetic and social works unit and the medical institute, which can be seen from the road. The wooden facade is completely rotten and falling down. Anybody seeing that as an advert for the Royal Shrewsbury hospital would be appalled, until they looked to the opposite side of the road and saw modern buildings and facilities--including administrative offices--to be proud of.

I have some questions for my hon. Friend the Minister. First, will she tell the people of Shrewsbury, Shropshire and mid-Wales that the Copthorne south site, where the most dilapidated buildings are, will be closed for good? Some buildings can be re-used and others are relatively new but, please, can we get rid of those wooden huts still housing patients? Secondly, when can we see some new buildings on the north side to let us transfer patients into modern facilities as part of a modern NHS, with well-motivated staff in the best possible working environment? Thirdly, will the Minister come to Shropshire to see the appalling conditions at the Copthorne south site?

I do not want politics to affect decisions, as happened in the time of the Tories, when there was an east-versus-west divide in the county and people could not agree that Copthorne south had to go. There has been too much talk and now it is time for action. There is universal agreement across mid-Wales, across the county, and further afield, because we take in patients from other counties, that we need investment and a new build now.

Finally, change is urgent for the patients and particularly the staff, who have to go into those buildings day in, day out. The buildings can be too cold or too hot or draughty. How can staff convince patients that they can be cured even though the roof might be falling in or leaking and the window panes are rattling? It is hard work for all the staff--auxiliaries, nurses, doctors, consultants and administrators. Now is the time to get the new building and deliver the modern NHS that the people of Shropshire deserve.

12.43 pm

Mr. Lembit Öpik (Montgomeryshire):
I pay tribute the hon. Member for Shrewsbury and Atcham (Mr. Marsden), who happens to be my neighbour, for the work that he has done to protect our hospital in a non-party political way. That hospital saved my life in 1998 when I had a serious accident and broke my back. Aside from that great contribution to society, it has also done great work for my constituents, my friends and some of my family. The hospital is a vital resource for Shrewsbury, for the whole of mid-Wales, including Montgomeryshire, Brecon and Radnor, and even further afield.

First, I hope that the Minister will confirm her support in principle for the continued operation and updating of the Royal Shrewsbury hospital, along the

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lines that the hon. Gentleman has suggested. Secondly, I hope that the Minister will take up the hon. Gentleman's invitation to visit that very important facility. The Minister would see staff committed to doing the best that they can, as well as the dilapidated buildings. More than anything, she would meet staff in touch with the needs of the region. I hope that she will take up the hon. Gentleman's offer and visit a success story in medicine that, with a little investment and planning, can continue to serve Montgomeryshire, mid-Wales and Shropshire for many years to come.

12.45 pm

The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart
): I congratulate my hon. Friend the Member for Shrewsbury and Atcham (Mr. Marsden) on securing a debate about a subject that is of such importance to his constituents. I pay tribute to his consistent efforts and commitment to health provisions in his constituency--clearly demonstrated by the number of parliamentary questions that he has tabled on the subject over the years. None can doubt his dogged determination to improve his constituency's health facilities.

I welcome the opportunity to respond and outline the Government's progress in improving the quality of NHS facilities both across the country and in Shrewsbury. I am also grateful for the intervention of the hon. Member for Montgomeryshire (Mr. Öpik): approximately 20 per cent. of the Royal Shrewsbury hospital's facilities are used for his constituency.

The NHS plan promised major investment in new NHS buildings, and we are delivering on that promise. We now have the biggest ever hospital building programme in the history of the NHS. The development of the hospital building programme is largely attributable to our success with the private finance initiative and the increase in public capital expenditure, which will rise by almost 50 per cent. in real terms to £2.4 billion by 2001-02. The NHS plan also identified a further round of major hospital developments with a capital value of over £2 billion, details of which my right hon. Friend the Secretary of State will announce in due course.

Our aim is to eradicate old and inappropriate buildings, bringing NHS facilities up to the standard appropriate for modern clinical services--the standard that patients have a right to expect from a modern health service. Our hospital development programme will deliver 38 major new hospitals, 31 under the private finance initiative. Of the 38, 19 will be opened by 2003-04 and the other half will be well under construction. By 2010, 40 per cent. of the total value of the NHS estate will be less than 15 years old. Our buildings will be better designed and the procurement process more efficient.

In committing such major investment to new facilities, we must ensure that the basics are in place. That is why the NHS plan also includes our commitment to investing in cleaner hospitals, better hospital food and better access to facilities for patients. We are providing that in Shrewsbury. For example, we have invested about £1.5 million to provide extra critical care beds, with an additional nine beds at the Royal Shrewsbury and eight at the Princess Royal hospital. We have invested £100,000 at the Royal Shrewsbury

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hospital as part of our clean hospitals initiative, and we are providing extra resources to the local health authority. Indeed, in the next financial year, the health authority will receive an 8.7 per cent. cash increase of more than £23 million, which builds on the 9 per cent. cash increase that it received this financial year.

Collectively, those and many other elements that I could mention if time permitted will ensure that, in the future, patients locally will have the benefit of receiving hospital care with up-to-date equipment in facilities that are fit for the 21st century.

What about the problems at the Royal Shrewsbury hospital, which my hon. Friend so graphically illustrated? I was delighted that both hon. Members who spoke could do so from personal experience of the first-class medical treatment that the hospital provided.

Mr. Öpik
: I assure the Minister that I was indeed delighted to have had that experience and I probably speak for the hon. Member for Shrewsbury and Atcham too.

Ms Stuart
: Both hon. Members would have preferred not to make an appearance at the hospital, but they are living examples of the excellent clinical care that they received.

The Royal Shrewsbury hospital, which is located near the centre of the town, provides services from two sites--Copthorne north and Copthorne south. The sites are adjacent, but divided by Mytton Oak road, the arterial road from the town centre. I am more than aware, from personal experience, of what it is like when hospitals have to operate from two sites. Copthorne north, regarded as the main acute site for the Royal Shrewsbury hospital, houses a majority of acute services, including accident and emergency, and has 488 beds; Copthorne south has 68 beds. The north site is the newer, and much larger of the two, being a greenfield development that began in the late 1960s. The south site is older and based on single-storey, hutted accommodation. Of the 68 beds on the south site, 44 are situated within older accommodation, with the remaining 24 beds in a more modern, purpose-built unit. As they constitute only 9 per cent. of the total number of beds at the Royal Shrewsbury hospital, and only 5 per cent. of the total acute hospital beds in Shropshire, after taking account of the nearby Princess Royal hospital in Telford, I agree that the facilities provided are poor and must be replaced.

It is important to see the development as part of a strategic context for services across the region. Shropshire health authority is committed to ensuring that services re-provision maximises clinical advantages without compromising clinical safety and viability. To progress that aim, the west midlands regional office of the NHS executive asked the local health economy to produce a joint strategic plan. The plan not only considered the delivery of those objectives directly linked to hospital facilities, but addressed the known services issues related to clinical sub-specialisation across the county. The strategic plan also took account of the need to achieve financial stability to enable the delivery of both national and local priorities.

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Now that the strategic direction has been established, a key objective of the local health economy has been to develop robust plans to facilitate the movement of facilities on the Copthorne south site. The strategic outline to vacate Copthorne south was approved by the regional office in December 2000. An action plan and timetable for those, and the long-term changes that I shall outline shortly, were agreed at a meeting between key stakeholders at the beginning of January.

I assure my hon. Friend that relocation of services from Copthorne south and its subsequent closure, for which he asked, is a recognised priority both locally and regionally, with capital funding of £8 million already earmarked within the regional capital programme to take it forward. The plans are to provide a new emergency admissions unit on the north site, and an expansion of the accident and emergency department, an additional theatre and radiology capacity at Princess Royal hospital to accommodate service changes, the re-provision of physiotherapy services and new child development and locomotor assessment facilities in a community setting, the last of which I hope will delight the hon. Member for Montgomeryshire, in view of his earlier comments.

Public moneys will also fund the replacement of the training facilities, and the Royal Shrewsbury Hospital NHS trust is proceeding with arrangements to develop a new medical institute and postgraduate centre on its north side.

I recognise that my hon. Friend is keen that the planned developments progress as quickly as possible and the approved strategic outline case provides the framework for detailed service plans to be worked up by the end of February. The main priority to develop a new medical assessment unit on the Copthorne north site is scheduled for completion by the end of December 2002.

What about the longer-term provision of facilities on the site? I understand that the clinicians and hospital managers at the Royal Shrewsbury hospital have concluded, after looking at all the evidence, that a new ambulatory care centre would be the best solution to meet the health needs of people in west Shropshire. There are also proposals to build an acute rehabilitation unit on the north site encompassing a day hospital and physiotherapy services.

The trust believes that the scheme should be taken forward through a PFI arrangement as the capital cost is in excess of £10 million, and there is land to accommodate the new unit on the north site.

The strategic outline case will be taken forward through the development of two concurrent business cases, one for public capital and the other for private finance. I appreciate that there are concerns about the state of the buildings during the interim period. My hon. Friend has asked many parliamentary questions about health and safety and fire safety issues, of which he gave graphic examples. The inability to control temperature is not limited to old buildings; it happens in many a new building, including this one. My hon. Friend is right to raise the matter; we are providing new facilities but in the interim we must ensure that the facilities still used by staff and patients are safe.

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A survey carried out in 1985 on the buildings on the south site indicates that bringing all of the buildings up to modern standards or, where that is not practical, replacing them, would cost around £8.12 million. The trust working with the health authority has decided that such expenditure is not appropriate and that closure of the outdated facilities is the most appropriate solution. In the short term, steps have been taken to reduce the use of the site by patients and to ensure that a safe environment is maintained for those patients and staff that remain. The trust will ensure that that course of action will not have a detrimental effect on waiting lists or inconvenience patients.

Under the NHS plan, trusts are required to improve the standard of the environment for patients, and independent inspections are being carried out. I am pleased to report that the most recent inspection of the Royal Shrewsbury hospital in December 2000 recorded an overall score that indicated a good and improving position. I am also delighted at what the hospital had been doing, not just in terms of health and safety but in terms of investing money in cleaner hospitals. The £100,000 that it was given has been used to good effect, with money put into ward and common area decorations, upgraded toilets, furniture replacement and entrance refurbishment, staff uniforms, corridor lighting and improvement of signage. The trust is aware that it needs to provide both a safe and genuinely more pleasing environment.

I should address, briefly, my hon. Friend's concerns about fire safety. The plans for the vacation of Copthorne south will achieve compliance with fire safety regulations within the 31 March 2003 time scale, laid out in the health service circular 1999/191. Furthermore, risk management arrangements have been put in place by the trust to ensure that the appropriate level of safety is maintained in the interim period.

I pay tribute to the way in which key players in Shropshire have played their part in the development and progression of plans to address the current unsatisfactory position. My hon. Friend was absolutely right to say that there had, before 1997, been a culture of hospital trust being set against hospital trust. That has been overcome: we now have a degree of co-operation that we had not seen before. I know that local Members of Parliament play an important role in that process of working together, and that the plans are supported by all the key stakeholders, including, as I understand it, the community health council in the constituency of the hon. Member for Montgomeryshire, which shows that support goes across party lines.

The fulfilment of the plans will achieve a shared vision of the improvement of services for patients. Old, outdated buildings will be disposed of and instead, patients will benefit from a new, diagnostic treatment centre. This will enable the delivery of new services in new settings, consistent with the vision of services that we have outlined in the NHS plan. My hon. Friend asked me three questions, I hope that I have satisfactorily answered one and two.

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The third question was a repeated request for my right hon. Friend the Secretary of State for Health to visit my hon. Friend's constituency, and I am delighted to accept it in the knowledge that he would welcome me just as warmly. It is simply a question of arranging diaries. My visit would enable me to see for myself not only the conditions that he so graphically described but the good work being done on the new site, sometimes in spite of less than satisfactory environmental conditions. I understand that patient care there is excellent, but we need to improve, invest and build on that already existing success. From what I and hon. Members have said today, we are well on the way to doing that.